Module 3 - Beliefs, behaviours and systems in primary care
Module 3 looks specifically at the role of primary care in diagnosing cancer. It explores the attitudes and beliefs of General Practitioners (GPs) and also examines differences in primary care systems involved in diagnosing cancer. The aim of module 3 is to understand international differences in primary care that may impact on cancer survival. Together with the analyses from the other ICBP modules, results from Module 3 will inform healthcare policy in the UK in order to improve the number of people surviving from cancer.
Method and Fieldwork
The Primary Care Physician survey
An international group, led by Dr Peter Rose in England, has developed this survey. It will provide an insight into the contribution of variation in primary care management of symptoms to cancer outcomes. It consists of two parts:
A set of general questions relating to GP practice administration, access to diagnostics, training and education and availability of advice from secondary care. Some jurisdictions will also collect data on questions which are relevant to specific local issues, for example detail on clinical guidelines.
Two patient vignettes. The physician is asked to make choices about management in response to the presentation of the patient. The patient may or may not have cancer and this will be revealed at the end of the vignette. The vignettes aim to draw out any differences in the approach of primary care physicians to patients with these symptoms.
200 GPs per jurisdiction will be were surveyed in each jurisdiction. The approach to sampling varied in each jurisdiction due to differences in the availability of the contact details for primary care physicians.
The survey was rolled out to all 11 jurisdictions. Data collection was completed in 2014 and results were published in May 2015. The analysis of the patient scenarios showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each scenario and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables with the authors suggesting that Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer—either directly, or by specialist referral, to improve outcomes. To find out more about this study please click here
The study took a more in-depth look at differences in the healthcare system that might influence on the GP’s management of potential cancer patients. Researchers looked specifically at factors of the healthcare system that might impact upon GP behaviour and potentially provide insight into variation in international cancer survival. This study compared the healthcare systems of Australia, Canada, Norway, Sweden, Norway, Denmark and the UK. Comparisons were made using an existing framework developed by researchers.
The study identified a high degree of similarity between jurisdictions on factors such as financing, regulations and the role of the GP as a central figure in the treatment and care of patients. Differences were found in relation to the degree of centralisation over decision making, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems. The researchers highlighted that is not possible to make a causal link between any of these factors and cancer survival. Further research into these factors was recommended, including the impact of co-payments on the GP-patient relationship.
If you are interested in reading, ‘How might healthcare systems influence speed of cancer diagnosis: a narrative review’ this paper is available free of charge from the Social Science and Medicine journal.